Narcolepsy

  • Medical Author:
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Sleep Paralysis in Narcolepsy

Sleep paralysis is a feeling of being conscious but unable to move. It occurs when a person passes between stages of wakefulness and sleep. During these transitions, you may be unable to move or speak for a few seconds up to a few minutes. Some people may also feel pressure or a sense of choking. Sleep paralysis may accompany other sleep disorders such as narcolepsy. Narcolepsy is an overpowering need to sleep caused by a problem with the brain's ability to regulate sleep.

Quick GuideSleep Disorders: Insomnia, Sleep Apnea, and More

Sleep Disorders: Insomnia, Sleep Apnea, and More

Narcolepsy facts

  • Narcolepsy is a chronic disease of the central nervous system. Symptoms include excessive daytime sleepiness (EDS), sudden loss of muscle tone (cataplexy), distorted perceptions (hypnagogic hallucinations), inability to move or talk (sleep paralysis), disturbed nocturnal sleep, and automatic behavior.
  • Narcolepsy usually begins in teenagers or young adults and affects both sexes equally.
  • Abnormalities in the structure and function of a particular group of nerve cells in the brain called hypocretin neurons are thought to play a role in the development of narcolepsy.
  • The diagnosis of narcolepsy is based on a clinical evaluation, specific questionnaires, sleep logs or diaries, and the results of sleep laboratory tests (polysomnography and multiple sleep latency test).
  • Treatment options for narcolepsy include drug and behavioral modification therapies and disease-specific education of the patient and family members. The treatment is individualized, depending on the types and severity of the symptoms, the life conditions of the patients, and the specific goals of therapy.
  • Optimal management usually takes weeks to months to achieve and requires continued communication among the physician, patient, family members, and others.
  • Alerting medications are used for the treatment of excessive daytime sleepiness. Amphetamines and methylphenidate (Ritalin) are general CNS stimulants that decrease sleepiness and improve alertness. Modafinil (Provigil) and armondafinil (Nuvigil) have alerting effects similar to those of the traditional stimulants but has less undesirable side effects.
  • Anticataplectic medications are used to treat cataplexy, hypnagogic hallucinations, and sleep paralysis. Tricyclic antidepressants (TCAs) are often effective in controlling cataplexy, but also frequently produce side effects that limit their use.
  • Selective serotonin reuptake inhibitors (SSRIs) are also useful in the treatment of cataplexy and their side effects are milder. Sodium oxybate (Xyrem) is a medication with anticataplectic effects that also improves disturbed nocturnal sleep.
  • Behavioral approaches to treating narcolepsy include establishing a structured sleep-wake cycle and planned naps, and involve diet, exercise, and occupational, marriage, and family counseling.

What is narcolepsy?

Narcolepsy is a chronic disease of the central nervous system. Excessive daytime sleepiness (EDS) is the main symptom and is present in 100% of patients with narcolepsy. Other primary symptoms of narcolepsy include:

  • loss of muscle tone (cataplexy),
  • distorted perceptions (hypnagogic hallucinations), and
  • inability to move or talk (sleep paralysis).

Additional symptoms include disturbed nocturnal sleep and automatic behavior (patients carry out certain actions without conscious awareness). A 2014 study in the Journal of Sleep Medicine also reported that nightmares may be more prevalent in people with narcolepsy than in the general population. All the symptoms of narcolepsy may be present in various combinations and degrees of severity.

Narcolepsy usually begins in teenagers or young adults and affects both sexes equally. The first symptom of narcolepsy to appear is excessive daytime sleepiness, which may remain unrecognized for a long time in that it develops gradually over time. The other symptoms can follow excessive daytime sleepiness by months or years. Cataplexy may appear before symptoms of narcolepsy.

Medically Reviewed by a Doctor on 10/6/2016

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